Superior Capsule Reconstruction for Irreparable Massive Rotator Cuff Tears: Does It Make Sense? A Systematic Review of Early Clinical Evidence

Altıntaş, Burak; Scheidt, Michael; Kremser, Victor; Boykin, Robert E.; Bhatia, Sanjeev; Sajadi, Kaveh R.; Mair, Scott D.; Millett, Peter J.

doi:10.1177/0363546520904378

Cited by 49 publications

(48 citation statements)

References 46 publications

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“… 114 Finally, SCR is a promising procedure that remains, however, relatively new and is subject to further research regarding optimal graft choice and surgical technique to avoid excessive strain on the construct during activities of daily living. 115 , 116 …”

Section: Rotator Cuffmentioning

confidence: 99%

Shoulder biomechanics in normal and selected pathological conditions

et al. 2020

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The stability of the glenohumeral joint depends on soft tissue stabilizers, bone morphology and dynamic stabilizers such as the rotator cuff and long head of the biceps tendon. Shoulder stabilization techniques include anatomic procedures such as repair of the labrum or restoration of bone loss, but also non-anatomic options such as remplissage or tendon transfers. Rotator cuff repair should restore the cuff anatomy, reattach the rotator cable and respect the coracoacromial arch whenever possible. Tendon transfer, superior capsular reconstruction or balloon implantation have been proposed for irreparable lesions. Shoulder rehabilitation should focus on restoring balanced glenohumeral and scapular force couples in order to avoid an upward migration of the humeral head and secondary cuff impingement. The primary goal of cuff repair is to be as anatomic as possible and to create a biomechanically favourable environment for tendon healing. Cite this article: EFORT Open Rev 2020;5:508-518. DOI: 10.1302/2058-5241.5.200006

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Section: Rotator Cuffmentioning

confidence: 99%

Shoulder biomechanics in normal and selected pathological conditions

et al. 2020

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“…The current evidence suggests that for symptomatic cases of irreparable, massive RCTs, SCR is an alternative with good to excellent early clinical outcomes; however, long-term follow-up will determine the longevity and ultimate role of this method in the treatment of irreparable, massive RCTs. 70 SCR is performed in young patients with massive, irreparable posterosuperior RCTs with no arthritis and in patients with Goutallier fatty degeneration of stage 3 or higher with retraction of the supraspinatus or infraspinatus tendons going up to the glenoid or just medial to it. 71 It is contraindicated if a fixed high-riding humeral head is present.…”

Section: Superior Capsular Reconstructionmentioning

confidence: 99%

Consider Long Head of Biceps Tendon for Reconstruction of Massive, Irreparable Rotator Cuff Tear

Selim

Badawy

2021

Arthroscopy Techniques

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Despite the different treatment options for irreparable and massive rotator cuff tears (RCTs), there is no optimal treatment. Thirty percent of total RCTs can be classified as irreparable because of the massive tear size and severe muscle atrophy. The reported treatment failure rate is approximately 40% for massive RCTs. RCTs may be treated conservatively or surgically depending on pain, disability, and functional demands. The surgical treatment options are many, but decision making is a challenge; the real challenge is to apply the correct procedure for the correct indication in each patient. The long head of the biceps tendon (LHBT) was used for augmentation to bridge the gap in immobile, massive RCTs. An arthroscopic biceps-incorporating technique was used for repair of large and massive RCTs, avoiding undue tension on the rotator cuff (RC). Recently, the LHBT was used for superior capsular reconstruction. This article describes the use of the LHBT for reconstruction of massive and irreparable RCTs through the following steps: (1) open exposure of the RCT, (2) debridement and subacromial decompression, (3) biceps tenotomy at the LHBT's origin on the glenoid, (4) LHBT and RC cuff mobilization, (5) passage of the LHBT through the mobilized RC and reflection onto itself, (6) tuberoplasty, and (7) fixation of the RC complex at the RC footprint.

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“…24 After Mihata et al 22 reported the clinical outcomes of 23 patients who underwent superior capsular reconstruction (SCR) using a fascia lata autograft, some authors reported favorable clinical outcomes of SCR. 1,6,12,16,17,21 In biomechanical studies, Mihata et al 23,25 also showed that SCR decreased superior migration of the humerus. Although cadaveric studies have demonstrated superior stability of the humerus, it remains unclear whether the humerus migrates superiorly after SCR in vivo.…”

mentioning

confidence: 99%

Comparison of Dynamic In Vivo Shoulder Kinematics Before and After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears

Lee

Min

Chung

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Superior capsular reconstruction (SCR) is an alternative surgical option for young active patients with irreparable rotator cuff tears without arthritis. Although cadaveric studies have shown superior stability of the humerus, it remains unclear whether the humerus migrates superiorly after SCR in vivo. Purpose: To analyze the change in glenohumeral translation in patients before and after SCR. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 patients who underwent SCR by a single surgeon for irreparable rotator cuff tears were included. Among them, 14 patients had intact grafts, and 8 patients were diagnosed with retears on 1-year postoperative magnetic resonance imaging (MRI) scans. Fluoroscopy was performed in all patients preoperatively and at 3-month, 6-month, and 1-year follow-up. Moreover, 3-dimensional bone models from computed tomography, MRI, and fluoroscopic scans during scapular plane abduction of the shoulder joints were analyzed. Results: In the intact graft group, 3-dimensional dynamic shoulder kinematics at 6 months ( P = .026) and 1 year ( P = .032) postoperatively showed statistically significant decreases in humeral head superior translation compared with preoperatively. The ≥6-mm acromiohumeral distance (AHD) subgroup had a larger decrease in humeral head superior translation from preoperatively than did the <6-mm AHD subgroup (6 months: P = .026; 1 year: P = .032). The retear group had significantly greater humeral head superior translation at 1 year postoperatively than did the ≥6-mm and <6-mm AHD subgroups (post hoc test: P < .001; ≥6-mm AHD vs retear group: P = .001; <6-mm AHD vs retear group: P = .012). Conclusion: SCR with intact grafts resulted in decreased humeral head superior translation after 6 months. Patients with retears showed no improvement in humeral head superior translation. Patients with a preoperative AHD <6 mm had less improvement in humeral head superior translation than did those with a preoperative AHD ≥6 mm. Early surgical treatment before an excessive decrease in preoperative AHD could be helpful for postoperative humeral head translation recovery.

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Superior Capsule Reconstruction for Irreparable Massive Rotator Cuff Tears: Does It Make Sense? A Systematic Review of Early Clinical Evidence

Cited by 49 publications

References 46 publications

Shoulder biomechanics in normal and selected pathological conditions

Shoulder biomechanics in normal and selected pathological conditions

Consider Long Head of Biceps Tendon for Reconstruction of Massive, Irreparable Rotator Cuff Tear

Comparison of Dynamic In Vivo Shoulder Kinematics Before and After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears

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